Job Description

Responsible for leadership and mentoring of the clinical network managers serving customers across multiple markets. Lead the clinical network managers in developing collaborative relationships with facilities and health care systems to develop innovative solutions and deliver quality outcomes. Responsible for building partnerships with business, account management, clinical, quality, legal, product innovation, and other departments to develop and maintain high performance behavioral health, substance use disorder, and specialty networks to provide the clinical delivery systems to support member and customer needs.

RESPONSIBILITIES

Development and maintenance of standardized processes, desk top procedures, policies, project plans, tools, templates, and training and onboarding materials for clinical network managers

Communicate roles and responsibilities and set expectations for clinical network managers

Work with clinical network managers to develop relationships with facilities that align with New Directions clinical philosophy, support evidence based practices, lead to the development of innovative programs and services and transform the network from fee for service to value based performance arrangements

Partner with business and account management to develop and maintain customer relationships, participate in meetings with customers, and serve as the lead network point of contact

Review and discuss quality indicators and outcomes with contracting staff and network management which may be associated with value based arrangements

Serve as the primary network representative to review clinical, quality, and network scorecards and dashboard metrics and collaborate to streamline processes to effectively communicate, address, and resolve root causes of poor provider performance

Investigate and resolve complaints as forwarded by the quality department and/or at customer request

Monitor development of annual site visit plan and schedule

Facilitate and/or participate in Membership Committees to review provider requests to join the network – determine needs for inclusion based on established criteria

Contribute to the design, implementation, and assessment of specialized clinical programs in support of members with various care needs. Develop high risk, high cost specialty networks addressing: chronic and relapsing mental health conditions, substance use dependence, child and adolescent mental health, eating disorders, and autism.

Collaborate on development of provider networks and systems which address integration with physical health providers and offer alternatives to traditional and/or higher levels of care

Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, and other designated information.

This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities as deemed necessary.